Doctors Support Clinton Vaccine Plan

Several Medical School and School of Public Health faculty members have expressed praise for a vaccine distribution program currently under consideration by the Clinton administration. But doctors cautioned that the current proposal is only a first step.

Dean of the School of Public Health Dr. Harvey V. Fineberg '67 called the proposal "a very significant step forward" in federal health care policy.

The program, which calls for government purchase of vaccines from pharmaceutical companies to remove tremendous cost barriers, would make possible free distribution of the medicines to public clinics, HMOs, and private doctors.

The cost of a primary immunization series for children under onr year of age, which currently, runs over $200, presents a significant obstacle for low-income families. Many whose incomes are too high for Medicaid benefits still cannot afford to pay for the medication.

But removing the cost barrier, however, may not be enough to boost immunization rates, the doctors said.

For the program to be most effective, Fineberg said, "we need to couple it with much more extensive outreach" so that more children can be inoculated earlier in life.

Parental education is a key element for effectiveness, according to Associate Professor of Pediatrics Dr. Marie C. McCormick.

"Many parents are afraid to have their children inoculated because they fear health risks," McCormick said. "They need to be made aware of the rarity of such adverse effects."

Dr. Gerald Hass, assistant clinical professor of pediatrics, said one reason too few children are reached is the current delivery system for vaccines. Many of those for whom vaccines are available do not take advantage of existing programs, he said.

Free distribution programs such as the one proposed by the Clinton administration, work well only when people take advantage of available health care, Hass said. Such a system, on a smaller-scale, is already in effect in the state of Massachusetts.

At the South End Community Health Center in Boston, where Hass practices, the immunization rate among the approximately 9,000 children treated regularly is over 90 percent.

But impressive as the figure is, Hass points out that it does not account for the many children in the area who do not access such health care at all.

While Massachusetts' vaccine distribution program has lowered prices on vaccines, it has not tackled the issue of incorporating more people into the health care system.

Recognition of this problem, shared by many; states, prompted experts attending a conference at the National Institutes of Health last week to demand an improved tracking system to monitor immunization records of U.S-born children.

In interviews this past week, McCormick proposed such a record be set up along with a child's birth certificate, and Fineberg suggested a nationwide central database. The database would not only maintain children's health records but also provide demographic data on the success and range of the Clinton administration's vaccination program.

But such systems are ideals, both McCormick and Fineberg acknowledged, which must face many logistic difficulties. Observers suggest that vaccine research and development will be stunted by the Clinton administration vaccination plan.

Pharmaceutical companies, faced with government-induced monopoly, would lose much of their profit margin under the new plan. And since part of the profit from vaccines goes into further research, the federally mandated price ceilings could result in decreased research.

Nonetheless, Fineberg believes the plan is consistent with vaccine research efforts since it provides an assured market for successful vaccines.

Fineberg also said research incentives to pharmaceutical companies, in the form of tax breaks and investment credits, could make up for some of the lost profits.

On the other hand, McCormick pointed out much of the current vaccine research in the United Stated is already subsidized by the National Institutes of Infectious Disease, whose support, she said, will "clearly continue."

The faculty members unanimously agreed a federal vaccine distribution program is a promising sign of an invigorated health care system in this country.

The proposal indicates "we have a President who has forcefully expressed concern in protecting newborns from preventable diseases and who has taken action to provide resources so that all people can have access to needed health care," Fineberg said.

'We have a President who...has taken action to provide resources so that all people can have access to needed health care.' School of Public Health Dean Harvey V. Fineberg '67